22 Jul No Difference in PCI Stent Surgery Mortality Performed With/Without Surgical Support
Medical Research: What is the background for this study?
Dr. Garg: In contrast to other countries, in particular the United States, the UK has seen a vast expansion in the number of PCI centres operating without on-site surgical support. Part of the reason for this is that outcome data from these centres are from modest populations at short-term follow-up; consequently the ACC/AHA have failed to give delivery of PCI in centres without surgical back-up a strong endorsement. The study was ultimately driven therefore to show whether any differences existed in mortality between patients having PCI in centres with- and without surgical support at long-term follow-up in large unselected population cohort.
Medical Research: What are the main findings?
Dr. Garg: The study included the largest population of patients treated in centres without off-site surgical support (n=119,036) and main findings were that following multi-variate adjustment there were no differences in mortality for patients treated at centres with- or without surgical support at 30-days, 1-year or 5-year follow-up irrespective of whether patients were treated for stable angina, NSTEMI or STEMI. Furthermore, similar results were seen in a sensitivity analysis of a propensity matched cohort of 74,001 patients.
Medical Research: What should clinicians and patients take away from your report?
Dr. Garg: These data should provide reassurance to clinicians and patients. For clinicians it shows that performing PCI in centres without surgical support is safe, and not associated with an additional mortality hazard. Importantly the population studied was unrestricted including complex patients with multi-vessel disease, chronic total occlusions, left main stem lesions and bypass graft cases. These data show that the location of where the PCI is performed is not important, however this does not remove the importance of ensuring an appropriate forum is in place, such as Heart Team conference, to guarantee that the most appropriate mode of revascularization is being selected. These data should help reassure patients that having their PCI in a local hospital which does not have on-site surgery, does not mean that they are having a risker procedure or one that is associated with poor outcomes.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Garg: We would hope that the study would prompt researchers in other countries to report outcomes from centres without on-site surgical support from their national registries with expectation that this will better inform as to whether any specific patients benefit from procedures performed at centres at which on-site surgical support is available. We would also hope that the data can be used to support a stronger recommendation from the ACC/AHA for performing PCI in centres with off-site surgical support.
Garg S, Anderson SG, Oldroyd K, et al. Outcomes of percutaneous coronary intervention performed at offsite versus onsite surgical centers in the United Kingdom. J Am Coll Cardiol 2015; 66:363-372. Abstract
Dr Scot Garg FRCP PhD (Hons) FESC (2015). No Difference in PCI Stent Surgery Mortality Performed With/Without Surgical Support